• Anu Thukral, Rakesh Lodha, Mohammad Irshad, and Narendra K Arora.
• Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
• Pediatr Crit Care Me. 2006 Jul 1;7(4):356-61.

ObjectiveTo determine the discriminative ability and calibration of existing scoring systems in predicting the outcome (mortality) in children admitted to an Indian pediatric intensive care unit (PICU).DesignProspective cohort study.SettingPediatric Intensive Care Unit, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, from July 1, 2002, to July 31, 2003.PatientsA total of 246 patients were admitted. After exclusion of 29 neonates and two patients who stayed in the PICU for InterventionsNone.Measurements And Main ResultsDiscrimination between death and survival was assessed by calculating the area under the receiver operating characteristic curve for each model. The areas under the curve (95% confidence intervals) for Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality (PIM), and PIM2 were 0.80 (0.74-0.86), 0.82 (0.76-0.88), and 0.81 (0.75-0.87), respectively. The area under the receiver operating characteristic curves was significantly greater for older children compared with infants. The existing scores underpredicted the mortality; the standardized mortality ratios (SMRs) (95% confidence interval) using PRISM, PIM, and PIM2 models were 1.20 (0.94-1.50), 1.57 (1.24-1.96), and 1.57 (1.24-1.59), respectively. The SMRs were higher in children with severe malnutrition, those with underlying illness, and those with serum albumin ConclusionsThe area under the receiver operating characteristic curve for all the models evaluated was >0.8. However, all the models underpredicted mortality. The likely reasons for this could be differences in the patient profile and greater load of severity of illness being managed with lesser resources--both physical and human--and differences in the quality of care.

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